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9 <br />APPLICATIOIr 'FOR CONSTRUCTICIIII PERMIT <br />M Evmgfmn <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK -PLEASE PRINT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑BUILDING El MECHANICAL CLUMBING <br />CffY ZIP PHONE <br />OWNER _ MAIL ADDRESS _ ' `r rfTt i. K 7 C h- ai l(A IF <br />MAIL <br />(:R<EW ❑ ADDITION ❑ ALTERATION <br />TENANT IMPROVEMENT OR INTERIOR REMCDEL ONLY <br />LOT BLOCK <br />SINK <br />IRA <br />CITY ZIP <br />w <br />❑ SIGN <br />❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPL INSERT ❑ BUILDING RELOCATION <br />CONTACT PERSON AND PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND. CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF TOWHICH <br />APPLICATIIONISISROPERTY MADE ANDPRFORM IE COMPLY WITTHEOHKT ER STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />ACI LI V�uI <br />' <br />FORCED AIR SYSTEMS-B.T.U. <br />' <br />UNIT HEATERS -BTU. M <br />(WASH BASIN) <br />I <br />CLOTHES DRYERS <br />' <br />VENTILATION FAN <br />INK & DISP <br />RANGE HOOD <br />' <br />ER <br />� <br />WATER HEATER <br />� <br />FRAY <br />I <br />WOOD STOVE <br />' <br />MASHER <br />METAL FIREPLACE & CHIMNEY <br />' <br />FIREPLACE INSERT <br />' <br />FOUNTAIN <br />I <br />HEAT PUMP <br />AIN <br />I GAS PIPING <br />FRONT SETBACK <br />USEZONE <br />TYPE OF CONST. ALLOWABLE <br />SIZE OF BLDG. <br />OCCUPANCYLOAD <br />REASON FOR SPRINKLERS <br />APPLICATION ACC. BY <br />REAR SETBACK <br />LOT AREA <br />TYPE OF CONST. ACTUAL <br />NO. OF STORIES <br />FIRE SPRNKLERS RECD <br />Cl YES ❑ NO <br />PLANS APPROVED BY <br />$ <br />SIDE SETBACK <br />VACANT SITE <br />Cl YES ❑ NO <br />BASEMENT <br />❑ YES ❑ NO <br />HEIGHT LIMITATION <br />CITY OF LOCAL SALEST TAX CODE IS 3105 <br />PLAN CHECK NUMBER <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />PERMIT $ <br />TOTAL FEE $ <br />FEE RECEIPT NO. <br />d <br />fl <br />